<%@ page language="java" contentType="text/html; charset=UTF-8"
    pageEncoding="UTF-8"%>
<%@ taglib prefix="c" uri="http://java.sun.com/jsp/jstl/core"%>
<c:set var="ctx" value="${pageContext.request.contextPath}" />
<% String appPath = request.getContextPath();%>  
<!DOCTYPE html>
<html>
  <head>
    <title>预约挂号</title>
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <!-- Bootstrap -->
    <link rel="stylesheet" href="http://cdn.bootcss.com/twitter-bootstrap/3.0.3/css/bootstrap.min.css">
	
	<style type="text/css">
		body{font-family:"ff-tisa-web-pro-1","ff-tisa-web-pro-2","Lucida Grande","Helvetica Neue",Helvetica,Arial,"Hiragino Sans GB","Hiragino Sans GB W3","WenQuanYi Micro Hei",sans-serif;}
h1, .h1, h2, .h2, h3, .h3, h4, .h4, .lead {font-family:"ff-tisa-web-pro-1","ff-tisa-web-pro-2","Lucida Grande","Helvetica Neue",Helvetica,Arial,"Hiragino Sans GB","Hiragino Sans GB W3","Microsoft YaHei UI","Microsoft YaHei","WenQuanYi Micro Hei",sans-serif;}
	
	</style>
    <!-- HTML5 Shim and Respond.js IE8 support of HTML5 elements and media queries -->
    <!-- WARNING: Respond.js doesn't work if you view the page via file:// -->
    <!--[if lt IE 9]>
        <script src="http://cdn.bootcss.com/html5shiv/3.7.0/html5shiv.min.js"></script>
        <script src="http://cdn.bootcss.com/respond.js/1.3.0/respond.min.js"></script>
    <![endif]-->
  </head>
  <body>
	
<div class="container">
<br>
<form id="step2form" class="form-horizontal" action="${ctx}/web/step3.jsp" method="post">
	<div class="form-group">
	    <label for="inputEmail3" class="col-xs-4 col-sm-2 control-label text-right">登记姓名：</label>
	    <div class="col-xs-8 col-sm-10">
	      <select name="name" class="form-control">
			  <option>科室一</option>
			  <option>科室二</option>
			</select>
	    </div>
   </div>
   <div class="form-group">
	    <label for="idcard" class="col-xs-4 col-sm-2 control-label text-right">身份证：</label>
	    <div class="col-xs-8 col-sm-10">
	     <input name="idcard" type="text" class="form-control" placeholder="身份证">
	    </div>
   </div>
    <div class="form-group">
	    <label for="birthday" class="col-xs-4 col-sm-2 control-label text-right">出生日期：</label>
	    <div class="col-xs-8 col-sm-10">
	     <input name="birthday" type="text" class="form-control" placeholder="出生日期">
	    </div>
   </div>
   <div class="form-group">
	    <label for="sex" class="col-xs-4 col-sm-2 control-label text-right">性别：</label>
	    <div class="col-xs-8 col-sm-10">
	     <div class="radio-inline">
		  <label>
		    <input type="radio" name="sex" id="optionsRadios1" value="option1" checked>
		           男
		  </label>
		  </div>
		   <div class="radio-inline">
		  <label>
		    <input type="radio" name="sex" id="optionsRadios1" value="option1">
		           女
		  </label>
		  </div>
	    </div>
   </div>
    <div class="form-group">
	    <label for="phone" class="col-xs-4 col-sm-2 control-label text-right">手机号：</label>
	    <div class="col-xs-8 col-sm-10">
	     <input type="text" class="form-control" placeholder="手机号">
	    </div>
   </div>
   <div class="form-group">
   	   <label for="sex" class="col-xs-4 col-sm-2 control-label text-right">症状 ：</label>
   	    <div class="col-xs-8 col-sm-10">
	   <div class="checkbox-inline">
		  <label>
		    <input type="checkbox" name="checkbox" id="checkbox1" value="option1">
		   	 感冒
		  </label>
		</div>
		<div class="checkbox-inline">
		  <label>
		    <input type="checkbox" name="checkbox" id="checkbox2" value="option2">
		   	 发烧
		  </label>
		</div>
		<div class="checkbox-inline">
		  <label>
		    <input type="checkbox" name="checkbox" id="checkbox3" value="option3">
		   	 咳嗽
		  </label>
		</div>
		</div>
	 </div>

<div class="row">
  
  <div class="text-center col-xs-12 col-sm-12"><button id="sbtn" type="button" class="btn btn-primary col-xs-12 col-sm-12">提交</button></div>
  <!-- Optional: clear the XS cols if their content doesn't match in height -->
  <div class="clearfix visible-xs"></div>
</div>


</form>
</div>

<!-- jQuery (necessary for Bootstrap's JavaScript plugins) -->
<script src="http://cdn.bootcss.com/jquery/1.10.2/jquery.min.js"></script>
<!-- Include all compiled plugins (below), or include individual files as needed -->
<script src="http://cdn.bootcss.com/twitter-bootstrap/3.0.3/js/bootstrap.min.js"></script>

<script type="text/javascript">

$(document).ready(function(){
	$("#sbtn").click(nextStep);
});


function nextStep(){
	$("#step2form").submit();
}

</script>
  </body>
</html>